1. Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Enhancing Organizational Research in Health Care Quality Speakers Jeff Alexander, PhD, University of Michigan David Nerenz, PhD, Henry Ford Health System Beth Feldpush, MPH, American Hospital Association

2. Advancing Excellence in Health Care What is this about? The IOM report “Crossing the Chasm” (2001) calls for improving healthcare organizations in order to improve quality of care.The IOM report “Crossing the Chasm” (2001) calls for improving healthcare organizations in order to improve quality of care. But there seems to be a “chasm” between researchers and healthcare executives.But there seems to be a “chasm” between researchers and healthcare executives. This session features presentations and discussion on what the key issues are and what we can do to bridge the gaps.This session features presentations and discussion on what the key issues are and what we can do to bridge the gaps.

3. Advancing Excellence in Health Care Speakers Jeff Alexander, Ph.D. University of Michigan David Nerenz, Ph.D. Henry Ford Health System Beth Feldpush, M.P.H. American Hospital Association

4. Advancing Excellence in Health Care We can we do to go from here to there? A Broken and Abandoned Bridge? A Golden Bridge?

5. Advancing Excellence in Health Care Discussion Jeff Alexander: Not all organizations are alike, therefore need “middle ground between individually tailoring approaches and one size fits all formulas” Question -- What is that middle ground? Jeff Alexander: Not all organizations are alike, therefore need “middle ground between individually tailoring approaches and one size fits all formulas” Question -- What is that middle ground? David Nerenz: - Researchers are concerned about cause-effect relationship that can be generalizable. - Managers look for implementable solutions to their daily problems or directions for their organization. And they have to fit the local context of individual organizations. Question -- How can these two be reconciled? David Nerenz: - Researchers are concerned about cause-effect relationship that can be generalizable. - Managers look for implementable solutions to their daily problems or directions for their organization. And they have to fit the local context of individual organizations. Question -- How can these two be reconciled?

6. Advancing Excellence in Health Care Building the Bridge to the Other Side – A Different Research Paradigm (David Nerenz) Clinician researchers – those who actually do patient care should be those who design, test, and refine health care delivery innovations. Clinician researchers – those who actually do patient care should be those who design, test, and refine health care delivery innovations. Research in clinic and inpatient unit “laboratories” – example – Mayo Clinic’s SPARC unit. Research done in organizations, not about organizations. Research in clinic and inpatient unit “laboratories” – example – Mayo Clinic’s SPARC unit. Research done in organizations, not about organizations. Research on truly new things to determine whether they can work, rather than on big, already-implemented things to determine whether they do work (or did work!). Research on truly new things to determine whether they can work, rather than on big, already-implemented things to determine whether they do work (or did work!). Focus on managers’ problems rather than policy-makers’ problems – e.g., reducing medical errors, reducing no-shows, enhancing interpreter services, reducing inefficiency and duplication…. (industrial engineering) Focus on managers’ problems rather than policy-makers’ problems – e.g., reducing medical errors, reducing no-shows, enhancing interpreter services, reducing inefficiency and duplication…. (industrial engineering) Small, bite-size problems rather than large, mega-problems (not, “Do EMRs enhance quality of care?”, but 100 specific questions on how to create or enhance an effect of a specific EMR system on quality of care) Small, bite-size problems rather than large, mega-problems (not, “Do EMRs enhance quality of care?”, but 100 specific questions on how to create or enhance an effect of a specific EMR system on quality of care) Explicit study attention paid to local context effects and interactions rather than use of randomization designs and regression models to eliminate them. Explicit study attention paid to local context effects and interactions rather than use of randomization designs and regression models to eliminate them.

7. Advancing Excellence in Health Care Discussion Question: Does the paradigm proposed by David sound a bit too pessimistic? Would it seem to reduce research into OR (Operational Research) type of studies or narrow our efforts to just doing small-scaled demonstration projects?

8. Advancing Excellence in Health Care Discussion AHA seems to have assumed a role of middleman in bridging the gap between researchers and managers – dig out research evidence, synthesize them, and translate into practical how-to-guide. Question -- Who else should or can take this role as well? AHA seems to have assumed a role of middleman in bridging the gap between researchers and managers – dig out research evidence, synthesize them, and translate into practical how-to-guide. Question -- Who else should or can take this role as well? The AHA hospital survey so far represents the largest hospital sample. But the focus is primarily on hospital structural characteristics, services, utilization, and financial information. Question -- How likely for AHA to develop other surveys to look at process, or leadership and culture? The AHA hospital survey so far represents the largest hospital sample. But the focus is primarily on hospital structural characteristics, services, utilization, and financial information. Question -- How likely for AHA to develop other surveys to look at process, or leadership and culture?

9. Advancing Excellence in Health Care Thank You!